The time between the last post (approximately 1 month ago) and today– that’s about how long it takes for a new antidepressant to take effect.
“So many people aren’t shopping for a year,” the psychiatric nurse practitioner said to me as I sat in her office. I told her it was based on an article by Ann Patchett for the New York Times. “Yeah I know. I read the article,” she continued. “Didn’t convince me to give up shopping for a year.”
I liked her. That was funny.
I don’t have an inflammatory disease, an autoimmune disease, or anything that lab work and physical exams can identify as causing pain in joints, fatigue, and malaise. Low on vitamin D. So what? Who isn’t? No smoking gun. Never a smoking gun. I wanted a label, a rug under which to tidily sweep all this into a pile, to validate and authenticate my experience. There wasn’t one, except as the rheumatologist suggested while I cried in frustration in her office, “I think its time to look at how well your depression is actually under control.”
I hadn’t seen a psychiatrist of psychiatric nurse practitioner in fifteen years. My GP wrote for Wellbutrin and the Celexa that was added four years ago when I had a similar bout of unexplained aches, pains, and fruitless testing. Being referred–even by my GP– back to psychiatry didn’t offend me nearly as much as it seemed to offend everyone else. I know I’m not crazy– or I am– but that’s one label I find pretty meaningless. Crazy means both “mentally deranged” and “extremely enthusiastic.” Its broad. I’m not mentally deranged, but extremely enthusiastic? I like to think so… It can also mean full of cracks or flaws, impractical, and being out of the ordinary. Yes. Yes I am.
I laid myself out for the nurse practitioner the best I could. I gave her the rough, over-arching history, then explained that since mid-January I’d been under the weather. I had sharp shooting pains in my toe. My heels hurt. My wrists and fingers hurt. I felt exhausted. Of course I didn’t feel like doing much, I didn’t feel well, I said in response to a depression assessment question. And that’s the trouble with chronic pain– even low-grade functional pain– sooner or later, its bound to get your down and when it does it creates this whole chicken or the egg depression issue. And as I sat there, I literally visualized myself holding a clucking, unruly white chicken in my left arm, and a brown spotted egg in my right hand and saying, “Look lady, I don’t know which came first. But here we are. Does it even matter anymore? Crack the egg, shoot the chicken, just please– help me.”
She started me on Effexor, which I took in my early twenties. I don’t remember much about my early twenties but I remember Effexor worked quickly and also that getting off of it was kind of like I imagine getting off heroine to be. I mentioned this to the nurse practitioner and she said she doesn’t worry about taking people off a medication when she’s looking for a long-term solution to a long-term problem. That logic worked for me. Plus, her reasoning for choosing Effexor was sound (it works fast, its good for pain.)
I have a friend who is new to therapy, and she is learning a lot about herself and how she adapted growing up. And that is great for her! I think everyone should take some time to reflect on their childhood at some point. I have. But my friend asked why I didn’t consider working at what was underneath the depression and anxiety, really getting to the root cause so I didn’t have to rely on pharmaceuticals. My face flushed with anger. I could have gotten in a big old ugly fight over that one. At this point in my life, looking for the root cause would be like trying to find the issue triggering epilepsy. Its brain chemistry, neuro-electrical firings and mis-firings.
I wanted to go all Lady Gaga on her and just yell, “Baby I was born this way!”
And that doesn’t alleviate my responsibility to act in my own best interest. Because I also believe I was born an alcoholic and an addict, but if I’d never started drinking, that never would have materialized as a problem for me. There is a hilarious twelve-step speaker who says, if you were born an alcoholic, when did you do all your drinking? Because its a dangerous thing to relieve an alcoholic of their responsibility for their disease. No one poured those drinks down my throat.
Without revealing names and branches, my family tree is heavily weighted with mental health problems. And even if mental health is not your cross, I’m sure we can all sit back and identify some way in which we are genetically screwed. So what? Do we draw the curtains and wait it out? Wait for the heart disease or diabetes or breast cancer to come your way? Of course not. As Dylan Thomas, we fight it out, we “rage rage against the dying of the light.”
But therein lies the rub of depression: it sucks the fight right out of our toes, making it feel like we are swimming through molasses to act in our own best interest.
I nearly quit the challenge last month. I was so desperate to get out of my skin and catch a high. I’m sitting here on the other side, with the gift of Effexor working its chemical magic, sunlight streaming through my window (that’s not even a metaphor, its literally happening– right now) and the only reason I can give for not quitting is that I’ve had enough sobriety training to wait out the misery.
When days seem like a stupid series of meaningless, redundant, thankless, lunches-made and baths-had and finally self-tucked-in-bed, released in sleep, I have to hold on and keep going, and praying to find flecks of joy and real purpose, again.
If you haven’t read Paul Kalanithi’s, When Breath Becomes Air, I highly recommend it. It’s the memoir of a 36-year-old neurosurgeon dying of stage IV lung cancer, and its lovely and raw and breathtaking. In it, he repeatedly quotes Samuel Beckett’s line, “I can’t go on. I’ll go on.”
When life hits you with a phase where your first thought upon awakening is simply, “No.” this Beckett line is a rope dropped down the well.
I can’t go on. I’ll go on.
Very few people are lucky enough to respond so well to the first new medication sent their way, though in fairness I was able to list off a half-dozen that had not worked for me in the past, and that was helpful. Its been a shifting process, a slow diminishing of the aches, a gradual brightening of the sky. More concretely, instead of watching My 600 Pound Life alone in my bed, I find myself watching Schitt’s Creek on the couch with my husband.
Watch Schitt’s Creek. Its on Netflix. It is hilarious.
I can’t recall a time in my life where I have responded to my alarm clock with a resounding, “YES!” (Does anyone do that besides Oprah?) But I’m meeting it now with an “alrighty,” and that is such a vast improvement if I weren’t so cried it, it could bring me to tears.